This invention relates generally to wheelchairs and more particularly concerns wheelchair seats.
Pressure sores are a major problem for many wheelchair patients. According to David Springer in Home Health Care Dealer Provider Magazine, xe2x80x9cPressure ulcers and related co-morbidities constitute the greatest impairment in quality of life, increase in expenses for care, and extended hospital stay for those requiring wheelchairs as their primary mode of locomotion.xe2x80x9d Pressure sores can develop quickly. The Merck Manual of Diagnosis and Therapy states, xe2x80x9cIn an immobilized patient, severe pressure can impair local circulation in less than three hours, causing local tissue anoxia that, if unrelieved, progresses to necrosis of the skin and subcutaneous tissues. Moisture (e.g., from perspiration or incontinence) leads to tissue maceration and predisposes to pressure sores.xe2x80x9d Moisture and pressure are the two most significant factors in the occurrence of pressure sores. In Drugs Aging, J. B. Young says, xe2x80x9cIt has been estimated that the United States spends five billion dollars annually on the treatment of pressure sores.xe2x80x9d
One major strategy for preventing pressure sores in wheelchair occupants is to distribute pressure as evenly as possible over the entire interface area between the seated individual and the wheelchair. In order to determine the most effective distribution of pressure, an industry accepted mapping system uses a 36 by 36 cell matrix of 1,296 pressure sensing transducer to determine the pressure pattern imposed on a seat by a wheelchair occupant. The test gives a computer screen visual of the cells to which pressure is applied and the magnitude of the pressure applied to each cell. Common areas where pressure sores develop include the soft tissue overlying the ischial tuberosities and coccyx, the former being the most common. These bony prominences cause acute areas of pressure in almost every seated individual, but this problem is exacerbated for wheelchair patients, and especially elderly wheelchair occupants. Because wheelchair patients are seated for extended periods of time, and do not tend to move around or shift in their seats often, the risk of pressure sores caused by unrelieved constant pressure and the buildup of moisture from perspiration is great. Circulation difficulties and poor seating posture further increase the risk of pressure sores. Furthermore, a wheelchair seat with perforations allows moisture and the heat which precedes moisture vapor to be exchanged with surrounding air. However, simple perforated seats do not provide suitable pressure distribution and do not fold, so the wheelchair is not as easily portable as a standard wheelchair.
One common method of reducing acute pressure areas for wheelchair patients is the use of seat cushions, which compress under bony prominences and/or offer more firm support in regions at less risk for developing pressure sores, such as the posterior thighs. While cushions of this type do lessen the load on sensitive areas of the skin, they do not always relieve enough pressure to encourage adequate circulation, nor do they always encourage good seating posture in wheelchair patients. Further, most cushions facilitate rather than minimize the occurrence and retention of moisture from perspiration at the seat interface because they use fabrics which do not breathe and because they increase the surface area in contact with the wheelchair patient. Seat cushions also have other incidental negatives such as adding weight to the chair and making transport of the chair more inconvenient. Added weight makes mobility more difficult for persons with impaired upper body strength. For active wheelchair users who are in and out of vehicles often, it is not always convenient to transport and handle a seat cushion in addition to the wheelchair itself.
Furthermore, seat cushions are not always available or practical. In many nursing homes and long term care facilities, wheelchairs are provided, but cushions are not provided. Most wheelchairs fold for ease of transport, but the cushion must be removed when the wheelchair is folded. Some cushions are contoured to predispose the pressure load to specific regions, usually the posterior thighs. When cushions are removed and then returned to wheelchair seats, they are sometimes inadvertently rotated so the orientation is improper and the pressure problem is actually aggravated for the wheelchair patient.
Another method of reducing acute pressure areas for wheelchair patients is the use of active pneumatic or hydraulic systems to control cushion pressure. Such systems, as exemplified by U.S. Pat. No. 6,092,249 to Kamen et al, require fluid reservoirs, pressure sources and regulators and pneumatically or hydraulically discrete chambers, all of which contribute to higher cost, greater weight, less convenience and burdensome maintenance while offering no relief for ventilation problems.
It is, therefore, an object of this invention to provide a wheelchair seat which helps prevent pressure sores from occurring. Another object of this invention is to provide a wheelchair seat which allows pressure to be more evenly distributed over its surface. A further object of this invention is to provide a wheelchair seat which reduces acute pressure areas for wheelchair patients. Yet another object of this invention is to provide a wheelchair seat which facilitates the exchange of moisture and moisture vapor with the surrounding air. It is also an object of this invention to provide a wheelchair seat which encourages adequate circulation in wheelchair patients. Still another object of this invention is to provide a wheelchair seat which provides good seating posture in wheelchair patients. An additional object of this invention is to provide a wheelchair seat which does not significantly increase the weight of a wheelchair. Another object of this invention is to provide a wheelchair seat which does not exacerbate the inconvenience associated with transporting a wheelchair. A further object of this invention is to provide a wheelchair seat which is easily adjusted in the event of a change of occupants. Yet another object of this invention is to provide a wheelchair seat which requires no pneumatic or hydraulic systems. It is also an object of this invention to provide a wheelchair seat which requires little maintenance.
In accordance with the invention, a wheelchair seat is provided which can be mounted on the seat rails or a pair of rods which may be provided on the seat rails of a typical wheelchair or on any pair of rods adapted to be rigidly fixed to and aligned in a longitudinal direction relative to the frame of the wheelchair. A lateral array of spaced apart substantially inelastic straps is extended between and engaged on the rods. A longitudinal array of spaced apart substantially inelastic straps is engaged on the forwardmost and rearwardmost straps of the lateral array. The longitudinal array traverses the lateral array to define a horizontal matrix of ventilating interstices. The length of any or all of the straps of the lateral array is independently adjustable to permit alteration of the pressure pattern imposed on the arrays by the patient occupying the seat.
The lateral strap adjustment is preferably accomplished by use of adjustable buckles, one on the end of each adjustable strap of the lateral array. The lateral straps are extended over, along side of and below the rods and buckle at a point under and between the rods. Inadvertent slipping of the buckles is preferably prevented by use of mating segments of hook-and-loop material fixed to the buckled straps to secure the end of the strap which is inserted through the buckle against a portion of the strap not inserted through the buckle.
The forward end of each longitudinal strap is permanently fixed to the forwardmost strap of the lateral array. The length of any or all of the straps of the longitudinal array may also be independently adjustable. Preferably this is accomplished by use of segments of hook-and-loop material. For each longitudinal strap which is to be adjustable, one segment is fixed to the rearward end of the longitudinal strap and the mating segment is fixed to the rearwardmost strap of the lateral array. Most preferably, each of the straps of the longitudinal array is centered along the forwardmost strap of the lateral array at a first set of distance intervals and each of the corresponding mating segments of hook-and-loop material is centered along the rearwardmost strap of the lateral array at a second set of distance intervals greater than the first set. This affords a seat surface which is wider at the rear than at the front and balances the diverging relationships of the longitudinal straps to maximize pressure pattern control.
Migration of any one or all of the straps of the lateral array in relation to an adjacent strap of the lateral array can be checked by interlacing any or all of the straps of the longitudinal array with the lateral straps to be checked and an adjacent lateral strap or by fixing one or more bands of material at their ends to straps of the longitudinal array to define retaining loops surrounding the lateral straps to be checked. Preferably, in the former embodiment, all of the lateral and longitudinal straps are interlaced to form a weave. In the prototype seat, a one-to-one warp-weft weave was used, but various warp-weft patterns can be used depending on the width and migrating characteristics of the straps. In the latter embodiment, the bands are fixed against the bottom surface of the straps of the longitudinal array so that the top surface of the arrays will be as smooth as possible.
Migration of the matrix in relation to the rods may be satisfactorily checked by the taut adjustment of the forwardmost and rearmost straps of the lateral array to the rods. It may be desirable, however, to further assure that migration of the forwardmost and rearwardmost straps on the rods is checked. This can be accomplished by use of four studs, one fixed proximate each end of the rods and abutting an edge of the forwardmost and rearwardmost straps of the lateral array.
It may also be desirable that the portions of each strap of the lateral and longitudinal arrays which define the matrix be individually encased in contour fitted tubes of substantially inelastic washable material. In one prototype, such tubes were stitched to the straps with strips of foam disposed between the top of each strap and its contour fitted tube.
A similar matrix can be used for the back of the wheelchair using the wheelchair back posts or any pair of rods adapted to be extended from and aligned in an upright direction relative to the wheelchair frame. A lateral array of spaced apart substantially inelastic straps is extended between and engaged on the upright rods and a vertical array of spaced apart substantially inelastic straps is engaged on the uppermost and lowermost of the straps of the upright lateral array. The vertical array traverses the upright lateral array to define a vertical matrix of ventilating interstices. Preferably, the length of any or all of the upright lateral straps can be independently adjusted to alter the pressure pattern imposed on the upright lateral and vertical arrays by the back of the occupant of the wheelchair. Migration of the uppermost strap in relation to the upright rods is checked by the tautness of the uppermost strap. However, two brackets, one fixed proximate each upper end of the upright rods and supporting the uppermost strap, may be used to assure minimal possibility of migration.
The prototype adjustable matrix wheelchair seat has been demonstrated to adequately simultaneously control pressure, allow ventilation and reduce moisture. In the event a patient should develop skin redness or irritation, the seat is readily adjustable to maintain effectiveness, even as the physical status of the wheelchair user changes. The seat is lightweight, attached to a standard wheelchair frame by means of the existing upholstery supports, and folds in the same fashion as standard upholstery to allow ease of transport. It is adjustable to create a flat, taut surface in its forward region and a well or hip-bucket of desired contour in its rear portion. It encourages good posture. The seat is made of inexpensive materials and construction is simple.